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研究生:張瑋玲
研究生(外文):Wei-Ling Chang
論文名稱:醫療市場競爭程度對醫療品質的影響
論文名稱(外文):The impact of health care competition on quality of care
指導教授:鄭守夏老師
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:衛生政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:95
中文關鍵詞:醫療品質醫療市場競爭
外文關鍵詞:quality of carehealth care competition
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背景
無論是醫療市場的競爭情形,亦或是醫療品質,一直是受到廣泛討論、重視的,且由於醫療市場的競爭,有大部分在於品質的競爭,而如此競爭的結果,民眾是否獲得了更好的醫療?由國內外研究可知,醫療市場的競爭對醫療品質可能會造成影響,但其影響的方向、程度為何則尚未有定論,需要更進一步的去分析、瞭解。

目的
瞭解台灣醫療品質的現況,並進一步瞭解在不同競爭程度之市場,醫療品質表現是否有不同。

方法
本研究為一橫斷性研究,研究對象為台灣地區地區教學以上醫院,品質指標為病人評估人際面品質、病人評估技術面品質、非預期再住院率、傷口感染率四項,市場競爭程度則以賀芬達指標作區分。複迴歸分析時,控制醫院之權屬別、層級別、疾病別、疾病的嚴重或複雜程度、年齡、性別、教育程度等變項來進行研究。本研究資料來源有三:「2002年出院病人調查問卷」、「2001、2002年全民健康保險學術資料庫」、「行政院衛生署2001年醫院服務量統計暨現況調查」。

結果
1.競爭程度高比競爭程度低的地區,在病人報告人際面品質評分較高。
2.競爭程度高比競爭程度低的地區,在病人報告技術面品質評分較高。
3.非預期再住院率為2.4%,競爭程度對再住院率的影響在統計上未達顯著。
4.闌尾炎傷口感染率為5.68%,競爭程度對傷口感染率的影響未達統計上之顯著。

結論
競爭程度的不同對民眾所評分的醫療品質有影響,在競爭程度高的地區,民眾所感受到的醫療品質無論是人際面或技術面皆較好;但競爭程度的不同對從常用的臨床醫療品質指標(非預期再住院率及傷口感染率)都無影響。故以整個研究結果而論,醫療市場之競爭對醫療品質之提升仍應是有正面意義的。


Background
Both of the competition of the medical market and the quality of health care have been discussed for a long time. Quality plays an important part in the competition. However, have people received better medical treatment after the result of the competition? From the present study, the competition may affect the quality, but there isn’t a final conclusion consistently about the level and the direction of the effect.

Objective
To realize the presence of healthcare quality in Taiwan, Furthermore, to indicate the quality performance difference in each competitive market.

Design
Our study is a cross sectional research. The hierarchy above the regional teaching hospital in Taiwan are the research subjects. The quality indicators are consisted of the interpersonal and technical quality of patient’s aspects, unscheduled readmission rate and wound infection rate. We used HHI as the indicator of the level of competition. We controlled hospitals’ ownership and hierarchy, the different diseases and severity, age, sex, education in multiple regression analysis. Our data sources were from 「2002 Discharged Patient Survey」, 「the National Health Insurance Research Database in 2001 and 2002」,and「the Annual National Hospital survey in 2001」.

Result
1.The score of the interpersonal quality in high competition area is higher than that in low competition area.
2.The score of the technical quality in high competition area is higher than that in low competition area.
3.Unscheduled readmission rate is 2.4%, and the effect of the level of the competition on readmission rate isn’t significant.
4.The wound infection rate of Appendectomy is 5.08%, and the effect of the level of the competition on wound infection rate isn’t significant.

Conclusion
The different level of competition can affect the quality of patient’s aspects. Patients get better medical quality both in the interpersonal or the technical quality of patient’s aspects when the level of competition is higher. But the different level of competition on clinical medical quality indicators (unscheduled readmission rate and wound infection rate) aren’t significant. Then, there could be positive influence on medial quality in more competitive medical market.


中文摘要 Ⅰ
Abstract Ⅱ
目錄 Ⅳ
表目錄 Ⅵ
圖目錄 Ⅷ


第一章 緒論
第一節 研究源起 1
第二節 研究目的 3

第二章 文獻探討
第一節 醫療品質的定義 4
第二節 品質的評估 6
第三節 病人報告醫療品質 14
第四節 再住院率與傷口感染率 16
第五節 競爭 23
第六節 競爭與品質 25


第三章 研究設計與方法
第一節 研究架構與假說 28
第二節 研究材料與方法 30
第三節 研究變項與操作型定義 34
第四節 分析方法 42

第四章 研究結果
子題一 病人品質評分與競爭程度 45
子題二 再住院率與競爭程度 56
子題三 傷口感染率與競爭程度 66

第五章 討論
第一節 競爭與品質測量的問題 76
第二節 競爭與品質的關係 80

第六章 結論及建議
第一節 結論 85
第二節 建議 87

附錄一 88
參考文獻 89


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